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HEALTH  SCIENCES  LIBRARY 

The  Sheldon  Peck  Collection 

on  the  History  of  Orthodontics 

and  Dental  Medicine 

Gift  of 

Sheldon  Peck,  DDS  1966 

and 

Leena  Peck,  DMD 

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The  Lukens  System 
of  Orthodontia 
Appliances 


By  C.  D.  Lukens,  D.  D.  S. 

SECOND  EDITION 


- PUBLISH  tD  BY - 

Lee  S.  Smith  &  Son 

- SOLE  AGENTS - 

Pittsburg, Pennsylvania,  U.  S.  A. 

Dr-  Bernhard  W.  Weinberger 
119  West  67th  St.,  New  Yerk 


ORTHODONTIA 

A  System  of  Correcting  Mai- Occlusion  of  the  Teeth  by  the  Use  of 
a  Limited  N  umber  of  Efficient  Appliances 

There  has  been  a  constant  and  pressing  demand  during  the 
past  few  years  by  the  dental  profession  for  more  simple,  efficient  and 
systematic  methods  of  correcting  irregularities  of  the  teeth.  The 
old  methods  of  inventing  and  constructing  appliances  for  each  case 
were  found  to  present  so  many  difficulties,  such  as  securing  proper 
material  and  tools,  immense  amount  of  time  consumed  in  their 
construction,  application  and  operation,  together  with  great  incon¬ 
venience  and  suffering  of  the  patient,  that  many  were  led  to 
abandon  this  important  branch  of  dental  science. 

With  the  introduction  of  ready-made  appliances  these  difficulties 
began  to  be  overcome,  and  new  interest  was  awakened  in  Ortho¬ 
dontia.  Improvements  in  appliances  have  been  constant,  with  a 
tendency  towards  simplicity  of  mechanical  principles  and  the 
reduction  of  parts. 

The  appliances  here  illustrated  offer  to  the  profession  a  system 
that  covers  the  widest  possible  range  of  cases  with  the  minimum  of 
working  parts  and  the  greatest  ease  of  manipulation.  They  are 
made  of  the  finest  quality  of  nickel  silver,  beautifully  finished  with 
a  triple  hand-burnished  gold  plate. 

SOLDERING 

For  the  uniting  of  plain  bands,  the  soldering  of  spurs,  or  where 
it  is  desirable  to  make  any  soldered  connection,  silver  solder  will  be 
found  the  most  desirable  medium  for  the  purpose,  using  borax  for 
flux.  However,  when  it  is  desirable  to  solder  a  small  spur  or  lug 
upon  the  expansion  areh  C,  jewelers’  soft  or  lead  solder  should  be 
used,  as  the  amount  of  heat  required  for  fusing  is  so  slight  that  it 
has  no  deleterious  effect  upon  either  the  temper  or  the  plating  of  the 
arch.  Phosphoric  acid,  as  it  is  furnished  for  cement  liquid,  is  the 
best  flux  for  this  purpose,  as  it  produces  no  oxidation. 

The  fine  flame  of  the  Herpath  blow  pipe  (Fig.  1)  will  be  found 
most  desirable  for  these  soldering  operations.  A  small  piece  of  well 
boraxed  silver  solder  should  first  be  fused  upon  the  end  of  the  spur 
wire  A.  By  holding  the  band  with  a  small  pair  of  soldering  pliers  the 
spur  wire  can  be  attached  at  any  indicated  position  after  which  it 
can  be  cut  off  to  the  desired  length  and  finished  with  the  file.  By 
confining  the  needle  point  of  the  flame  to  the  desired  point  of  attach¬ 
ment  a  spur  can  be  soldered  almost  in  contact  with  the  soldered 
seam  of  the  band  without  its  being  detached. 


~2— 


Fig.  1 


Spur  Wire  A. 


Enlarged  View  of  Anchor 
Band,  showing  hollow 
clamping  bolt 


Improved  Jack  Screw  D 


Extension  Sleeve  E 


Anchor  Bands 


M 


K  for  Molars  M  for  Bicuspids 


Coils  of  Band 
Material 

I 


Heavy 


Expansion  Arch  C 
c 


Retracting  Screw  F  and  Spur  Wire  H 

Br 


Light 


Retaining 
Pipes  B 


Fig.  2 


The  letters  used  to  designate  the  parts  of  the  appliances  as 
given  in  the  above  illustrations  will  be  used  in  the  description  of 
their  various  combinations  and  in  their  application  to  cases  of 
different  types. 


—4— 


GENERAL  DESCRIPTION  OF  PARTS 

Anchor  Bands  K  and  M — Fig.  2 

Anchor  bands  K  and  M  for  molars  and  bicuspids  respectively 
illustrate  a  most  marked  improvement  in  clamp  band  construction 
and  possess  many  valuable  features  which  will  be  described  fully 
as  their  combination  with  other  parts  are  considered. 

Jack  Screw  D  and  E — Fig.  2 

D  illustrates  the  improved  double  tubular  end  Jack  Screw,  and 
E  an  extra  long  sheath  for  use  where  it  is  desirable  to  span  a 
greater  space  than  can  be  covered  with  the  short  sheath.  The 
great  advantage  of  this  Jack  Screw  is  to  be  found  in  the  fact  that 
it  can  be  swung  from  short  spurs  soldered  to  bands  and  will  not 
readily  become  dislodged  upon  the  relinquishing  of  the  pressure 
due  to  tooth  movement. 

Band  Material  I  and  J — Fig.  2 

This  band  material  is  furnished  in  two  thicknesses,  J  being  the 
heavier  and  best  adapted  for  general  use,  while  I  is  lighter  and 
well  adapted  for  retention  and  similar  purposes.  It  is  highly 
polished  and  thoroughly  annealed,  thus  eliminating  the  necessity 
of  annealing  in  the  coil,  which  has  the  disadvantage  of  uncertainty, 
and  oxidizing  the  metal  to  such  an  extent  that  soldering  is  accom¬ 
plished  with  the  greatest  difficulty. 

Retracting  Screw  F  and  H — Fig.  2 

The  improved  tubular  end  retracting  screw  F  possesses  the 
quality  of  lightness  combined  with  great  strength.  Another  great 
advantage  in  its  favor  is  the  fact  that  it  can  be  placed  in  position  in 
combination  with  the  anchor  band  K  without  a  soldered  connection, 
thus  greatly  relieving  the  operator.  H  is  a  heavy  spur  wire  for 
making  the  attachment  to  the  band  on  the  moving  tooth. 

Retaining  Pipes  B — Fig.  2 

These  are  small  light  tubes  cut  in  assorted  lengths  and  are 
most  valuable  for  assisting  in  retention  and  making  various  con¬ 
nections  and  attachments. 

Spur  Wire  A— Fig.  2 

Is  a  length  of  annealed  nickel  silver  wire  drawn  to  perfectly  fit 
the  retaining  pipes  B,  and  is  used  for  making  spurs  upon  which  fit 
the  tubular  ends  of  the  Jack  Screw  D,  also  for  making  ligature 
attachments  to  bands,  and  is  a  valuable  adjunct  in  combination 
with  band  material  I  and  J  in  securing  retention. 


—5— 


Expansion  Arch  C — Fig.  2 

This  arch  is  made  of  the  finest  quality  nickel  silver.  A  most 
decided  advantage  will  be  found  in  the  high  spring  temper  it 
possesses.  The  threads  are  of  a  special  cut  and  number,  and  the 
nuts  are  long  and  accurately  fitted,  all  of  which  combine  to  make 
it  a  perfect  appliance.  Its  range  of  application  is  very  great,  in 
fact,  almost  universal. 

Wrench  L — Fig.  2 

This  wrench  is  made  to  fit  all  the  nuts  used  on  these  appliances 
as  well  as  the  clamping  bolts  of  the  Anchor  Bands  K  and  M. 


Fig.  3 

Elastic  Bronze  Ligature  Wire 

This  ligature  wire  is  especially  prepared  for  orthodontia  liga¬ 
tures  from  the  finest  quality  of  aluminum  bronze.  It  is  very  supple, 
highly  resistant  to  oxidation  and  possesses  a  peculiar  quality  of 
elasticity,  all  of  which  combine  to  make  it  the  ideal  ligature. 

Prepared  in  three  gauges,  26,  28,  30.  Price,  $1.00.  Per 
spool,  35  cents. 


Fig.  4 

B— $0.50  doz. 


Set  No.  1 


DESCRIPTION  OF  SETS  Nos.  1  and  2. 

The  individual  parts  of  the  appliances  just  described  have  been 
arranged  into  two  sets. 

Set  No.  1,  Fig.  4,  consists  of  two  molar  anchor  bands  K,  one 
expansion  arch  C,  one  coil  of  heavy  band  material  J,  one  coil  of 
light  band  material  I,  one  jack  screw  D  &  K,  one  retracting  screw 
F  &  H,  one  spur  wire  A  with  six  pipes  B  to  fit  the  same,  and  one 
wrench  L. 


Fig.  5 

A-$0.30 


Set  No.  2 


Set  No.  2,  Fig.  b,  contains  two  molar  anchor  bands  K,  one 
expansion  arch  C,  one  coil  of  heavy  band  material  J,  one  spur  wire 
A,  and  one  wrench  L.  This  latter  combination  of  parts  has  con¬ 
stantly  grown  in  popularity  since  its  introduction,  owing  to  the  fact 
that  all  the  parts  contained  in  this  set  are  necessary  for  the  correc¬ 
tion  of  so  large  a  percentage  of  cases,  whereas,  in  selecting  a  set  of 
larger  assortment,  extra  parts  often  remain  unused;  for  this  reason 
it  is  advisable  to  select  just  the  parts  needed  for  each  individual 
case  rather  then  to  select  by  sets,  except  in  those  cases  where  just 
the  number  of  parts  contained  in  either  the  No.  1  or  No.  2  sets  are 
required. 

COMBINATION  OF  THE  RETRACTING  SCREW 
WITH  ANCHOR  BAND 


In  combining  the  retracting  screw  F  and  the  molar  anchor  band, 
K  (Fig.  6)  for  the  retraction  of  the  cuspid  teeth,  the  first  essential 
is  the  proper  fitting  of  the  anchor  band  K  to  the  first  molar  (Fig.  7) . 


—8— 


This  should  be  accomplished  by  first  loosening  the  screw  and 
then  forming  the  anchor  band  K  to  the  shape  of  the  tooth,  approxi¬ 
mately,  with  a  pair  of  flat  nose  pliers;  the  band  should  then  be 
placed  on  the  tooth  with  the  hollow  clamping  bolt  on  the  buccal 
surface  and  the  square  or  wrench  end  of  the  bolt  toward  the  mesial; 
the  band  should  then  be  gently  forced  upon  the  tooth.  With  a 
moderate  amount  of  time  and  care  this  can  be  accomplished  in  almost 
every  instance  without  resorting  to  mechanical  separation  of  any 
kind.  Placing  one  end  of  the  wrench  or  a  piece  of  orange  wood 
across  the  edge  of  the  band  will  greatly  protect  the  fingers  as  well 
as  render  an  equal  distribution  of  force  in  carrying  the  band  to  the 
desired  position.  The  hollow  clamping  bolt  should  then  be  tight¬ 
ened  and  the  band  burnished  to  conform  to  the  irregular  surface  of 
the  tooth,  alternating  the  operation  of  tightening  and  burnishing 
until  the  band  is  firmly  fixed.  A  narrow  margin  of  the  band  should  be 
burnished  over  the  mesial  and  distal  marginal  ridges  to  prevent  the 
band  being  carried  too  far  toward  the  neck  of  the  tooth. 

The  advantages  of  this  band  are  manifold;  there  is  no  nut  and 
bolt  on  the  lingual  surface  to  irritate  or  interfere  with  the  tongue; 
the  clamping  bolt  is  easily  reached  with  the  wrench,  and  the  diffi¬ 
culty  of  soldering  and  aligning  a  tube  on  the  buccal  surface  for  the 
reception  of  the  retracting  screw  is  entirely  eliminated  (Fig.  8). 


Fig.  9 


In  making  the  application  of  the  anchor  band  K  and  the  retract¬ 
ing  screw  F  for  the  retraction  of  the  cuspid  tooth  (Fig.  9)  the  first 
procedure  is  the  fitting  of  band  K  to  the  first  molar  in  the  manner 
just  described;  then  make  a  band  of  the  heavy  band  material  J  to 
fit  the  cuspid.  On  the  labial  surface  of  this  band  solder  a  short 
spur  of  the  spur  wire  H  at  right  angles  to  the  long  axis  of  the 
tooth. 


—9— 


It  is  well  to  allow  these  bands  to  remain  in  place  for  about 
twenty-four  hours  to  secure  separation  of  the  teeth  so  they  can  be 
easily  slipped  on  and  off  while  cementing. 

The  cuspid  band  should  now  be  cemented  firmly  in  position. 
Remove  the  band  K  and  place  the  retracting  screw  F  through  the 
hollow  clamping  bolt,  placing  the  nut  in  such  position  that  it  will 
rest  against  the  distal  end  of  the  clamping  bolt.  Cut  off  with  the 
cutting  pliers,  or  file  any  excess  of  the  retracting  screw  that  may 
project  sufficiently  beyond  the  nut  to  irritate  the  cheek.  Carefully 
dry  the  first  molar,  fill  the  band  K  with  cement,  place  the  tubular 
end  of  the  retracting  screw  over  the  spur  H  on  the  cuspid  band  and 
carry  the  band  K  into  position,  quickly  tightening  the  clamping 
bolt  while  the  cement  is  still  soft. 


c 


—10— 


COMBINATION  OF  ANCHOR  BANDS  AND 
EXPANSION  ARCH 

The  combination  of  the  anchor  bands  K  and  expansion  arch  C 
is  almost  universal  in  its  application.  Fig.  10  shows  an  enlarged 
view  of  the  anchor  band  K.  Fig.  11,  the  expansion  arch  C  bent 
to  such  a  curve  as  to  give  the  greatest  possible  lateral  expansion. 
While  Figs.  12  and  13  show  it  bent  to  such  a  curve  as  would  be 
desirable  where  less  lateral  expansion  of  the  molars  is  required. 


Fig.  14 


—11— 


Fig.  14  illustrates  the  application  of  this  combination  for  the 
simultaneous  expansion  of  both  upper  and  lower  arches,  which  is 
very  desirable,  as  it  allows  the  placing  of  the  teeth  of  one  arch  in 
their  proper  relation  with  the  teeth  of  the  opposing  arch,  and  also 
greatl}^  reduces  the  time  of  treatment.  It  is  well  to  place  the  upper 
arch  in  position  first  and  allow  about  two  weeks  to  elapse  before 
placing  the  lower,  especially  in  cases  where  anterior  expansion  is 
required,  as  this  prevents  the  cutting  edges  of  the  lower  incisors 
from  bearing  heavily  upon  the  lingual  surface  of  the  upper. 

Figs.  15  and  16  show  the  application  in  detail  of  the  case 
illustrated  in  Fig.  14.  Fig.  15  shows  an  occlusal  view  of  the  upper 
arch. 

To  adjust  these  appliances  place  the  anchor  bands  K  on  each 
of  the  first  molars,  after  which  make  plain  bands  of  the  heavy 
band  material  J  to  fit  the  right  lateral  and  left  central  incisors.  On 
the  mesio-lingual  angle  of  each  of  these  bands  solder  a  short  spur 
of  the  spur  wire  A  and  cement  the  bands  in  position. 


Fig.  15 


Fig.  16 


As  in  the  case  of  the  bands  for  the  retracting  screw, *it  is  desir¬ 
able  to  allow  them  to  remain  in  place  for  about  twenty-four  hours 
before  cementing,  for  the  purpose  of  securing  sufficient  separation 
to  permit  easy  removal  and  affording  better  opportunity  for  drying 
between  the  teeth,  preparatory  to  cementing  them  in  place.  The 
expansion  arch  C  should  then  be  carefully  bent  to  conform  to  the 
dental  arch,  care  being  taken  not  to  allow  excessive  lateral  spring, 
unless  greater  width  in  the  molar  region  is  desired.  The  arch 
should  then  be  placed  in  position  with  the  nuts  resting  against  the 
mesial  end  of  the  hollow  clamping  bolts  of  the  anchor  bands  K, 
and  any  excess  of  the  arch  that  projects  beyond  the  distal  end  of 
the  clamping  bolts  cut  off  and  the  ends  rounded. 


—12— 


To  accomplish  lateral  expansion  of  the  bicuspids,  lace  them  to 
the  expansion  arch  C,  using  for  the  purpose  elastic  bronze  wire 
ligatures.  To  expand  in  the  anterior  region,  loop  the  ligatures 
over  the  spurs  A  on  the  bands  J  and  lace  to  the  arch.  This  will 
rotate  the  central  and  lateral  incisors  at  the  same  time  they  are  being 
carried  forward  into  their  proper  alignment.  If  it  is  desirable  to  move 
one  tooth  more  rapidly  than  the  others,  as  in  the  case  of  the  lateral 
incisor,  this  can  be  accomplished  by  more  repeated  lacing,  while 
collective  movement  of  the  anterior  teeth  can  be  readily  accom¬ 
plished  by  tightening  the  nuts  of  the  expansion  arch  C  against  the 
mesial  end  of  the  anchor  band  K. 

Fig.  16  shows  the  occlusal  view  of  the  lower  arch  in  Fig.  14. 


As  expansion  alone  is  here  required  without  the  rotation  of 
any  teeth,  it  is  only  necessary  to  place  the  anchor  bands  K  on  the 
first  molars  and  after  forming  the  expansion  arch  C  to  its  proper 


Fig.  17  Fig.  18 


shape,  place  it  in  position  and  lace  the  incisors  and  bicuspids, 
thereby  enlarging  the  dental  arch  in  every  direction,  so  as  to 
harmonize  in  size  and  shape  with  the  upper.  These  various 
appliances  should  be  placed  in  the  mouth  gradually,  allowing  some 
time  between  the  introduction  of  each  part.  By  so  doing,  the 
inconvenience  to  the  patient  will  be  reduced  to  the  minimum. 

Fig.  17  illustrates  a  case  where  greater  lateral  expansion  is 
required  to  provide  sufficient  space  to  rotate  the  two  central  and 
left  lateral  incisor  into  their  proper  position.  The  anchor  bands  K 
are  first  placed  upon  each  of  the  first  molars,  plain  bands  of  the 
heavy  band  material  J  are  then  placed  upon  both  central  incisors  and 
left  lateral,  with  short  spurs  of  the  spur  wire  A  soldered  upon  the 
disto-lingual  angle  of  each. 

The  expansion  arch  C  is  then  placed  in  position  with  the  nuts 


— i.s— 


resting  against  the  mesial  end  of  the  hollow  clamping  bolts  of  the 
bands  K.  The  various  teeth  are  then  laced  to  the  expansion  arch 
C  in  the  manner  previously  described,  using  the  spurs  on  the  incisor 
bands  for  attaching  the  ligatures,  which  brings  all  the  pressure  to 
bear  on  one  side  of  the  tooth,  so  it  will  be  rotated  at  the  same  time 
it  is  being  carried  forward. 

This  rotation  will  be  greatly  facilitated  by  placing  a  rubber 
wedge  R  between  the  arch  C  and  the  mesio-labial  angle  of  the  left 
central  incisor. 

Sufficient  space  should  be  provided  for  these  teeth  by  lateral 
expansion  before  rotation  is  attempted. 

Fig.  18  illustrates  a  case  where  it  is  desirable  to  modify  the 
shape  of  the  dental  arch  by  widening  the  lateral  halves  and  depressing 
the  central  incisors. 

The  anchor  bands  K  are  placed  on  the  first  molars,  while  plain 
bands  of  the  heavy  band  material  J  are  made  for  the  central  incisors. 

To  these  bands,  solder  short  spurs  of  the  spur  wire  A  on  the 
labial  surface  at  right  angels  to  the  long  axis  of  the  teeth.  The 
expansion  arch  C  is  then  placed  in  position  with  the  nuts  resting 
against  the  distal  end  of  the  hollow  clamping  bolts  of  the  bands  K. 
The  spurs  A  on  the  incisor  bands  will  prevent  the  arch  C  from 
being  carried  toward  the  gingival  line  when  these  nuts  are 
tightened  to  depress  the  central  incisors. 

The  lateral  halves  of  the  arch  are  widened  at  the  same  time  by 
lacing  the  cuspids  and  bicuspids  to  the  arch  C. 

To  eliminate  the  difficulty  often  experienced  in  placing  the 
arch  nuts  against  the  distal  ends  of  the  anchor  bolts,  it  is  best,  after 
bands  are  fitted  and  the  arch  adjusted,  to  remove  the  bands  K, 
place  them  on  the  arch  C,  and  screw  the  arch  nuts  into  position  ; 
then  return  the  combined  parts  to  the  mouth. 


—14— 


Fig.  19 


Fig.  19  illustrates  a  case  requiring  the  movement  of  all  the 
teeth  in  the  upper  arch  anterior  to  the  first  permanent  molars. 
The  anchor  bands  K  are  adjusted  to  the  first  molars,  and  plain 
bands  of  the  heavy  band  metal  J  are  made  to  fit  the  lateral 
incisors;  on  the  disto-lingual  angle  of  these  plain  bands  are  soldered 
short  spurs  of  the  spur  wire  A.  The  expansion  arch  C  is  then  made 
to  comform  in  a  general  way  to  the  shape  of  the  dental  arch  and 
placed  in  position.  The  central  incisors,  the  first  and  second  bicus¬ 
pids  on  each  side  and  the  lateral  incisors  are  now  laced  to  the  expan¬ 
sion  arch  C  with  elastic  bronze  ligature  wire.  In  the  case  of  the 
lateral  incisors  the  short  spur  on  the  disto-lingual  angles  of  the 
bands  are  used  to  engage  the  ligatures  for  the  purpose  of  accom¬ 
plishing  the  rotation  of  these  teeth.  The  small  rubber  wedges 
placed  between  the  expansion  arch  and  the  cuspid  teeth  greatly 
facilitate  their  lingual  movement. 


—15— 


Fig.  20 

Fig.  20  shows  a  case  where  the  cuspids  are  erupting  greatly 
to  the  lingual  of  their  normal  position  and  illustrates  the  application 
of  the  molar  anchor  bands  K  and  expansion  arch  C  for  the  correction 
of  the  condition.  The  anterior  and  lateral  portions  of  the  arch  are 
expanded  by  lacing  the  incisors  and  bicuspids  to  the  expansion  arch 
C  for  the  production  of  sufficient  space  to  bring  the  cuspids  into  the 
line  of  occlusion.  Pins  accurately  fitted  and  cemented  into  the 
lingual  surface  of  the  cuspids  forms  the  best  method  of  attachment 
for  lacing  these  teeth  to  the  expansion  arch  C.  The  rotation  of  the 
right  lateral  is  accomplished  by  making  a  band  of  the  heavy  band 
metal  J  with  a  short  spur  soldered  on  the  mesio  lingual  angle. 
This  spur  engages  the  wire  ligature  and  brings  all  the  force  on  the 
mesial  side  of  the  tooth.  This  is  re-enforced  by  a  rubber  wedge 
tightly  drawn  between  the  expansion  arch  C  and  the  disto  labial 
angle  of  the  tooth.  A  sharp  downward  bend  on  each  side  of  the 
expansion  arch  C  in  the  cuspid  region  greatly  increases  the  pressure 
on  the  cuspid  teeth  by  the  torsional  stress  that  is  brought  to  bear. 


—16— 


Fig.  21 


Fig.  21  illustrates  a  method  of  re-enforcing  the  molar  anchor¬ 
age  in  a  case  where  a  first  lower  molar  is  missing.  Molar  anchor 
bands  K  are  placed  on  the  left  first  molar  and  the  right  second 
molar;  also  a  bicuspid  anchor  band  M  on  the  second  right  bicuspid. 
The  expansion  arch  C  is  then  bent  to  closely  fit  the  dental  arch  and 
allow  its  insertion  into  the  hollow  clamping  bolts  of  these  anchor 
bands.  The  nut  on  the  right  side  of  the  arch  is  then  carried  as  far 
forward  as  the  threading  will  permit.  After  the  end  of  the  arch 
passes  through  the  hollow  clamping  bolt  of  the  bicuspid  anchor 
band  M,  a  second  nut  is  placed  on  the  end  of  the  arch  and  carried 
forward  sufficiently  far  to  allow  the  end  of  the  arch  to  enter  the 
clamping  bolt  of  the  molar  anchor  band  K,  while  the  left  side  of 
the  arch  enters  the  anchor  band  in  the  usual  manner.  The  expan¬ 
sion  of  the  dental  arch  and  rotation  of  the  cuspids  is  accomplished 
as  shown  in  the  illustration,  and  previously  described. 


—17— 


Fig.  22 

Fig.  22  illustrates  a  method  of  applying  the  intermaxillary 
force  for  shifting  the  teeth  upon  themselves  from  a  distal  to  a  normal 
position.  An  anchor  band  K  is  placed  on  the  first  lower  molar  and 
a  bicuspid  anchor  band  M  on  the  first  upper  bicuspid.  A  rubber 
band  is  then  placed  over  the  distal  end  of  the  clamping  bolt  on  the 
molar  and  over  the  mesial  end  of  the  clamping  bolt  on  the  bicuspid 
as  shown  in  the  illustration.  It  is  essential  that  this  force  be  very 
constant  in  its  application  until  the  teeth  have  moved  over  the  crest 
of  the  cusps  of  the  opposing  teeth,  when  the  tendency  is  for  them 
to  settle  into  their  normal  relation. 


APPLICATION  OF  JACK  SCREW 


Fig.  23 


Fig.  24 


Fig.  23  shows  the  double  tubular  end  jack  screw  D  and  K;  the 
long  sheath  E  is  for  use  where  it  is  necessary  to  span  a  greater  space 
than  can  be  covered  with  the  short  sheath. 

Fig.  24  shows  the  jack  screw  D  in  its  relation  to  bands  made  of 
the  heavy  band  material  J  to  which  have  been  soldered  spurs  of  the 
spur  wire  A,  which  engage  the  double  tubular  ends  of  the  jack  screw 
D  and  prevents  its  being  easly  dislodged  by  the  tongue  or  otherwise. 

—18— 


Fig.  25  Fig.  26 


Fig.  25  shows  the  jack  screw  D  in  place  for  the  purpose  of 
carrying  two  inlocked  cuspid  teeth  into  their  proper  alignment. 
Bands  are  first  made  of  the  heavy  band  material  J  to  fit  each  of  the 
cuspids;  on  the  lingual  surface  of  each  is  soldered  a  short  spur  of  the 
spur  wire  A  at  right  angles  to  the  long  axis  of  the  teeth;  then  place 
the  jack  screw  D  in  position  by  placing  the  double  tubular  ends  over 
the  spurs  A. 

Fig.  26  shows  the  corrected  case. 


— ly— 


Fig.  27 


Fig.  27  illustrates  a  combination  of  the  molar  clamp  band  K 
and  the  jack  screw  D  to  accomplish  the  rotation  of  a  first  superior 
bicuspid  where  the  diciduous  second  molars  were  still  in  position. 
A  band  is  made  of  the  heavy  band  metal  J  to  fit  the  bicuspid  to 
which  are  soldered  spurs  as  indicated.  A  molar  anchor  band  K  is 
then  placed  on  the  first  permanent  molar  with  a  .spur  soldered  to  its 
mesio  lingual  angle  and  the  tubular  end  of  the  jack  screw  D 
flattened  and  notched  to  engage  the  spur  on  the  buccal  surface  of 
the  bicuspid  band  and  placed  in  the  hollow  clamping  bolt  of  the 
anchor  band  K  with  the  nut  of  the  jack  screw  resting  against  the 
mesial  end  of  the  clamping  bolt.  A  heavy  rubber  ligature  engaging 
the  spurs  on  the  lingual  surface  of  the  bicuspid  and  molar  bands 
assists  in  bringing  the  bicuspid  in  to  the  line  of  occlusion  when 
pressure  is  brought  to  bear  on  the  buccal  surface  by  tightening  the 
nut  of  the  jack  screw  against  the  mesial  end  of  the  clamping  bolts 
of  the  anchor  band  K. 


—20— 


COMBINATIONS  FOR  THE  REDUCTION  OF  SPACE 
BETWEEN  THE  CENTRAL  INCISORS 


Spaces  of  varying  width  between  the  superior  central  incisors 
is  a  condition  of  frequent  occurrence ;  the  result  of  various  causes 
chief  of  which  is  the  excessive  development  and  low  attachment  of 
the  frenum  labi.  Its  removal  by  cauterization  and  prolonged 
retention  of  the  teeth  is  absolutely  essential  to  any  degree  of 
success  in  the  correction  of  this  condition. 


Fig.  28 


Fig  28  shows  a  method  of  moving  the  central  incisors  together 
in  cases  where  the  operator  is  in  perfect  control  of  the  patient  and 
can  tighten  or  replace  the  ligatures  about  every  second  day,  during 
a  longer  interval  of  time  the  ligature  is  liable  to  displacement. 
Bands  are  first  made  of  the  heavy  band  metal  J  to  perfectly  fit  each 
of  the  central  incisors  ;  on  the  mesio  labial  angle  of  each  band  is 
soldered  a  short  spur  of  the  spur  wire  A.  These  spurs  should  have 
a  slight  distal  inclination  to  better  retain  the  ligature  in  position. 
The  bands  are  then  cemented  firmly  in  place.  This  should  be 
accomplished  prior  to  the  removal  of  the  frenum  by  cauterization 
or  other  surgical  removal,  and  the  Fig.  8  ligature  of  elastic  bronze 
wire  28  gauge  applied  at  the  same  sitting. 


—21— 


Fig.  29 

Fig.  29  illustrates  a  method  of  reducing  this  space  by  means 
of  an  anchor  band  K.  This  will  be  found  a  very  efficient  method 
of  reduction  in  cases  of  slight  separation. 


Fig.  30 

Fig.  30  shows  a  most  efficient  method  of  carrying  the  central 
incisors  together  in  cases  where  the  separation  is  very  marked. 
Bands  of  the  heavy  band  metal  J  are  made  to  fit  each  of  the  central 
incisors.  The  smooth  bore  and  threaded  eyelets  of  the  molar 
anchor  band  K  are  then  detached  by  holding  them  over  the  flame 
of  the  blow-pipe  and  resolder  to  the  mesio  labial  angle  of  the  plain 
bands.  The  clamping  bolt  is  then  placed  in  position  as  shown  in  the 
illustration.  This  makes  a  very  positive  appliance  and  one  that 
can  be  readily  operated  by  the  patient. 


-22- 


COMBINATIONS  FOR  SECURING  FIXATION  IN  CASES 

OF  FRACTURED  MANDIBLE 


Fig.  31  shows  a  method  of  fixation  in  a  case  where  the  fracture 
extends  through  the  ramus  just  above  the  angle  of  the  mandible. 
An  anchor  band  K  is  adjusted  to  the  lower  first  molar  and  a 
bicuspid  band  M  to  the  first  upper  bicuspid,  and  both  firmly 
cemented  in  position.  This  places  the  bands  in  such  relation  to 
each  other  that  when  the  26  gauge  wire  ligature  is  placed  through 
the  hollow  clamping  bolts,  and  pressure  brought  to  bear  on  this 
ligature  by  twisting,  the  tendency  is  to  carry  the  mandible  up  and 


Fig.  31 


forward  until  the  teeth  are  in  correct  occlusion.  This  interlocking 
of  the  cusps  greatly  assists  in  retaining  the  anterior  fragment  in 
position.  A  material  advantage  is  gained  by  placing  the  ligature 
through  the  long  hollow  clamping  bolts  of  the  bands,  as  a  greater 
and  more  even  distribution  of  force  is  secured  than  where  spurs  are 
used  for  the  attachment  of  the  ligatures.  In  case  of  bi-lateral 
fracture  of  the  rami,  this  combination  placed  on  each  side  affords  a 
most  efficient  method  of  fixation. 


—23— 


Fig.  32 

Fig.  32  shows  a  very  common  fracture  of  the  mandible  extend¬ 
ing  through  the  body  of  the  bone  between  the  first  molar  and  sec¬ 
ond  bicuspid  involving  the  mental  foramen.  The  combination  of 
appliances  shown  in  the  illustration  is  a  most  satisfactory  method  of 
holding  the  parts  in  position.  A  molar  anchor  band  K  is  placed  on 
the  first  molar  and  a  bicuspid  band  M  on  the  cuspid;  a  short  section 
of  the  arch  C  is  then  placed  through  the  hollow  clamping  bolts  of 
the  bands  with  the  nuts  placed  in  such  position  that  they  bear 
against  the  mesial  end  of  the  clamping  bolt  of  the  cuspid  band  and 
the  distal  end  of  the  molar  band.  This  holds  the  parts  in  perfect 
position  and  allows  the  patient  the  free  movement  of  the  mandible. 


—24— 


A  FEW  CASES  CORRECTED  WITH  LUKENS 

APPLIANCES 

Fig.  33 


No.  1  No.  2 

Fig.  33,  No.  1,  illustrates  a  very  interesting  case  of  excessive 
development  of  the  right  central  incisor  in  the  mouth  of  a  patient 
fifteen  years  of  age.  This  tooth  was  much  wider  mesio-distally 
than  its  companion,  and  was  a  full  third  longer  from  the  gingival 
line  to  the  incisal  edge,  with  the  right  lateral  lapping  well  over  its 
disto-labial  surface. 

Both  arches  were  expanded  by  means  of  the  expansion  arch  C, 
and  after  being  brought  into  harmonious  relation  with  each  other, 
the  right  central  was  ground  to  conform  in  size  and  shape  to  the 
left  central,  No.  2. 

Fig.  3t 


No.  3  No.  4 

Fig.  34,  No.  3,  shows  a  case  with  the  left  central  and  lateral 
inlocked  to  a  very  marked  degree.  This  case  was  corrected  by 


—25— 


expanding  both  arches,  using  the  expansion  arch  C  in  combination 
with  the  anchor  bands  K.  No.  4  shows  the  corrected  case. 


Fig.  35 


No.  5  No.  6 


Fig.  35,  No.  5,  illustrates  a  case  where  the  upper  incisors  were 
occluding  to  the  lingual  of  the  lowers,  in  a  patient  nine  years  of  age. 

No.  6  shows  the  case  after  they  were  carried  forward  to  their 
correct  positions  by  means  of  the  expansion  arch  C. 


Fig.  36 


No.  7  No.  8 


Fig.  36,  No.  7,  shows  a  case  at  nine  years  of  age  where  it  was 
necessary  to  slightly  expand  both  arches  with  the  expansion  arch 
C  to  provide  space  to  rotate  the  incoming  upper  lateral  incisors  into 
their  correct  position,  as  shown  in  No  8. 


—26— 


Fig.  37 


No.  9 


No.  10 


Fig.  37,  No.  9,  illustrates  a  case  where  both  arches  were 
expanded  to  their  full  size  by  means  of  the  expansion  arch  C,  as 
shown  in  No.  10. 


Fig.  38 


No.  11  No.  12 


Fig.  38,  No.  11,  shows  another  case  where  the  expansion  of 
both  arches  was  necessary  in  order  to  provide  space  for  all  the  teeth. 

This  case  shows  the  great  amount  of  expansion  that  can  be 
accomplished  with  the  expansion  arch  C  in  combination  with  the 
anchor  bands  K. 

No.  12  shows  the  case  corrected. 

—27— 


Fig.  39 


No.  13 


No.  14 


Fig.  39,  No.  13,  illustrates  a  case  of  anterior  protrusion  due  to 
lip  biting,  and  corrected  by  using  the  expansion  arch  as  illustrated 
in  Fig.  16.  No.  14  shows  finished  case. 

Fig.  40 


No.  15  No.  16 

Fig.  40,  No.  15,  illustrates  a  case  of  most  marked  separation 
of  the  upper  central  incisors  in  a  patient  twenty-three  years  of  age. 
The  lateral  incisor  on  the  right  side  was  missing,  and  the  cuspid  in 
contact  with  the  central.  Plain  bands  were  made  of  the  band 
material  J  for  each  of  the  central  incisors,  on  the  mesio-labial  angle 
of  which  was  soldered  short  spurs  of  the  spur  wire  A  and  the  cen¬ 
trals  brought  together  by  a  figure  eight  ligature  reaching  from  one 
spur  to  the  other,  which  was  replaced  every  second  day;  the  cuspid 
was  carried  back  by  means  of  the  retracting  screw  F ;  this  provided 
space  for  the  introduction  of  an  artificial  lateral  incisor,  as  shown 
in  No.  16. 


—28— 


PRESS  OF 

GOTTSCHALK  PRINTING  COMPANY 
SAINT  LOUIS 


